The long awaited report following the public inquiry chaired by Robert Francis QC into events at Mid Staffordshire NHS Foundation Trust has now been published and makes for difficult reading. Having heard from 164 oral witnesses and a further 87 witness statements read out, it should come as no surprise that the report itself runs to 1,782 pages with 290 recommendations.
The report surmises that the "invidious negative culture" and tolerance of poor standards and disengagement from managerial and leadership responsibilities were at the heart of the issues and Robert Francis QC attempts to address this in his recommendations. Of particular note:
- Patients should be put first and patients and their families should be involved in patient care
- Regulation should be simplified with, for example, the responsibility of regulating governance of healthcare providers being transferred from Monitor to CQC
- Compliance with "Fundamental Standards" should be undertaken by CQC with NICE providing indications/ metrics for measuring compliance. The "Fundamental Standards" should presumably be developed by the Department of Health
- CQC will be responsible for the enforcement of compliance with standards. CQC should be able to take immediate proactive steps in the interests of patient safety, even whilst considering or investigating the extent of non-compliance
- Non compliance with a "Fundamental Standard" leading to death or serious harm of a patient by an individual or organisation should be capable of being prosecuted as a criminal offence
- Trusts applying for FT status should meet the "Fundamental Standards" at the time date of the application. Applicants should be under a duty of "utmost good faith" to disclose any significant information material to the application
- Board level directions should have to comply with a code of conduct and face disqualification from their role unless they are a fit and proper person
- Monitor and CQC should set out guidance for Governors to assist in recognising the importance/ accountability of the public role of a Governor
- The NHSLA should consider more demanding levels for financial incentivisation
- Any expression of concern made, for example, to a clinician or nurse, should be treated as a formal complaint
- There should be a statutory obligation of candour on healthcare providers, practitioners and directors of organisations
- A criminal offence should be created for registered professionals to obstruct the performance of regulators by dishonestly or recklessly making an untruth to a regulator
- There should be a change in the culture of compassion in respect of nurses. There should be a responsible nurse in each Trust accountable to the NMC. The NMC should consider implementing aptitude tests for aspiring nurses to ensure that they are compassionate people
- Healthcare Support workers should be registered by the NMC
- The GMC/NMC should have policies in place as to when they expect complaints to be reported to them. The GMC/NMC together with CQC when necessary should consider commissioning peer reviews in certain circumstances
- There should be a public debate before any significant change to the NHS
Readers should remind themselves that these are recommendations and that Parliament will be considering which (if any) recommendations to carry forward. There has, however, been an early indication by the Government that the majority of the recommendations will be accepted. Some recommendations (such as the registration of health support workers) will be both anticipated and welcomed. Others (such as the likely increased frequency of complaints) may place an onerous responsibility on healthcare providers and commissioners.
Clyde and Co LLP awaits with interest the Government's reaction to this report and will be providing a training seminar, with details to follow, to consider the report and likely implications on providers, commissioners and practitioners in the changing healthcare landscape.
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